Modern Phase-Specific Management of Acute Pancreatitis
Modern Phase-Specific Management of Acute Pancreatitis
复制标题
急性胰腺炎的现代阶段特异性治疗
作者：
J. Werner;W. Uhl;W. Hartwig;T. Hackert;C. Müller;O. Strobel;M. Büchler
过去几年，急性坏死性胰腺炎的治疗发生了显着变化。与过去的早期手术干预相比，现在有一种强烈的趋势是采取更保守的方法。最初，重症急性胰腺炎的特征是全身炎症反应综合征。早期治疗是非手术且仅支持性的。目前尚不存在具体的治疗方法。在坏死性疾病的情况下，应预防性使用抗生素以减少晚期脓毒症并发症。如今，由于重症监护医学的进步，更多的患者在重症胰腺炎的第一阶段幸存下来，从而增加了后期败血症的风险。胰腺感染是重症急性胰腺炎第二期发病和死亡的主要危险因素。虽然早期手术和无菌性坏死手术只能在选定的病例中推荐，但胰腺感染是疾病第二阶段手术治疗的公认适应症。手术最好推迟到症状出现后 4 周，因为那时坏死已经明确界定。三种手术技术可以进行，在死亡率方面具有可比的结果：坏死组织切除术结合（1）开放式填塞技术，（2）计划分期重新剖腹术并反复灌洗，或（3）腹膜后封闭连续灌洗。然而，与其他方法相比，后一种方法似乎具有最低的发病率。
The management of acute necrotizing pancreatitis has changed significantly over the past years. In contrast to the early surgical intervention of the past, there is now a strong tendency towards a more conservative approach. Initially, severe acute pancreatitis is characterized by the systemic inflammatory response syndrome. Early management is non-surgically and solely supportive. A specific treatment still does not exist. In cases of necrotizing disease, prophylactic antibiotics should be applied to reduce late septic complications. Today, more patients survive the first phase of severe pancreatitis due to improvements of intensive care medicine, thus increasing the risk of later sepsis. Pancreatic infection is the major risk factor with regard to morbidity and mortality in the second phase of severe acute pancreatitis. Whereas early surgery and surgery for sterile necrosis can only be recommended in selected cases, pancreatic infection is a well-accepted indication for surgical treatment in the second phase of the disease. Surgery should ideally be postponed until 4 weeks after the onset of symptoms, as necrosis is well demarcated at that time. Three surgical techniques can be performed with comparable results regarding mortality: necrosectomy combined with the (1) open packing technique, (2) planned staged relaparotomies with repeated lavage, or (3) closed continuous lavage of the retroperitoneum. However, the latter method seems to be associated with the lowest morbidity compared to the other approaches.
负鼠急性胰腺炎败血症的机制。
DOI：
10.1016/s0002-9610(99)80142-1
发表时间：
1995
期刊：
American journal of surgery.
影响因子：
--
作者：
Runkel,NS;Rodriguez,LF;Moody,FG
通讯作者：
Moody,FG
实验性胰腺炎的细胞生物学。
DOI：
10.1056/nejm198701153160306
发表时间：
1987
期刊：
The New England journal of medicine
影响因子：
--
作者：
Steer,ML;Meldolesi,J
通讯作者：
Meldolesi,J